Chilaiditi sign

The Chilaiditi sign refers to the interposition of intestine (usually transverse colon) between the liver and the diaphragm.

A rare anatomical variant, it is seen in around 0.025–0.28%1 of abdominal x‐rays. The exact cause is unknown, but it can be associated with dolichocolon (abnormally long colon) and absence or laxity of abdominal ligaments (including the falciform ligament or the transverse mesocolon).

As in this case, the condition is commonly asymptomatic and an incidental finding. When associated with symptoms such as pain or shortness of breath, it is referred to as Chilaiditi syndrome. It is perhaps most notable as a possible cause of pseudopneumoperitoneum, making it appear as if there were free air below the diaphragm.